Individual provider · Type 1 NPI

Kathleen Waggoner Petty, LCSW, CSAC

Mental Health Counselor · Lansdowne, VA

NPI number 1811206204 Active

Practice location

19441 Golf Vista Plz, Suite 110
Lansdowne, VA 20176-8269

Call (703) 402-3080 Map

Mailing address

2607 Deerdell Ln
Reston, VA 20191-2114

Specialties and licenses

TaxonomyCodeLicense
Addiction (Substance Use Disorder) Counselor 101YA0400XNone listed
Mental Health Counselor Primary 101YM0800XNone listed

Mental Health Counselor: Definition to come...

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About NPI 1811206204

Kathleen Waggoner Petty, LCSW, CSAC's National Provider Identifier is 1811206204, issued on Oct 1, 2010. The primary taxonomy on file is Mental Health Counselor (101YM0800X), and the practice location is in Lansdowne, VA. The record was last updated on Oct 1, 2010.